1. Falls Prevention in the Community: Putting the evidence into practice Dr Fiona Shaw Chair, Safer Care North East Falls Task Group Consultant Physician and Geriatrician Newcastle upon Tyne Hospitals NHS Foundation Trust (NHS Newcastle and North Tyneside Community Health)

2. Overview Safer Care North East Consensus good practice recommendations Regionally suggested A&E Falls and Fractures CQUIN Information sharing website Care homes (In-patient audit tool) Regional outcome measures Joint working with North East Ambulance Service Staying Steady Community Exercise Classes Key lessons Future plans

3. Safer Care North East North East Patient Safety Strategic Forum - established by North East SHA in February 2008 Safer Care North East Strategy – 3 year programme Enabling strategy – regionwide developments complemented by developments within individual trusts and localities No avoidable deaths, injury or illness Linked with other programmes: Our Vision Our Future, North East Transformation System

4. Safer Care North East Improvement 8 (9) clinical safety themes: deteriorating patient drug safety healthcare associated infection suicide safe surgery care transfers, handovers and discharges falls action on outlying mortality (safeguarding) Priority themes identified by / from: SUI / NRLS Local trusts National priorities Evidence based guidance Clinicians / managers PSSF Leadership and alignment Systems and processes People

5. Why falls (and fractures)? BIG cause of HARM Average PCT / LA: 2200 A&E attendances, 1,100 fractures including 360 hip fractures per year 4x increased chance of admission to care home Loss of confidence, social isolation, increased mortality Cost = £2.5 million per annum Falls and fractures are PREVENTABLE Multi-factorial intervention reduces falls in community dwellers, hospital patients and care home residents by about 30% Targeted exercise reduces falls in selected community dwellers by about 30% Osteoporosis treatment would prevent 105 fractures, including 55 hip fractures per PCT / LA area in 5 years Money saved = estimated £750,000 per year

6. Safer Care Falls Task Group ‘Do something’ to reduce falls and fractures Across region Doctors, nurses, falls co-ordinators, physiotherapists, OT’s, pharmacist, NEAS, osteoporosis specialists, third sector, commissioners Link individuals and services to: Share good practice ‘Collective voice’ to argue for change Support change needed for wider implementation of good practice

7. To reduce the number of hip fractures and other adverse outcomes following a fall To reduce the number of falls in hospitals / in-patient facilities To reduce the number of falls in care homes To promote use of multi-factorial falls assessment and intervention, including diagnosis and treatment of osteoporosis To improve the quality of falls data collection and reporting of falls To achieve a whole system approach to falls prevention by collaborative working across primary and secondary health care, independent care providers, social services and the voluntary sector Safer Care Falls Task Group: OGIM

8. So what did the Falls Task Group do?

9. Consensus recommendations Organisational issues Services delivered In-patient / hospital falls Care homes Training Information Quality metrics Services mapped themselves against recommendations…

10. Service mapping…… Individual issues addressed: Funding for Osteoporosis Specialist Nurse Development of Falls Training Recurrent themes identified across region: Lack of robust pathways of referral from A&E to falls services Assessment and treatment of osteoporosis

11. A&E Falls (and fractures) CQUIN Any suggestions?

12. Falls (and fractures) CQUIN 2011/2012 written by Falls Group Capture of falls information in A&E Evidence of timely referral to falls service for patients who present to A&E with: A fall A blackout A fracture relating to a fall Evidence of timely and appropriate assessment by falls service including: Initial falls assessment Screening for osteoporosis Falls Service

13. Falls (and fractures) CQUIN: Pilot data Wansbeck General Hospital Led by Dr. David A. Richardson (Falls Service) and Dr. Phil Stamp (A&E) Northumbria Healthcare NHS Foundation Trust 1 2 1 – full pilot begins 2 – new staff QC 30 20 10 Referrals from A&E per week

14. Falls (and fractures) CQUIN: Pilot data Wansbeck General Hospital Actual number of fallers n = 63 Refsn = 12

15. Falls (and fractures) CQUIN: Pilot data Wansbeck General Hospital Referred to FASS OPD 50% No follow-up required 20% Other 3% Reviewed on ward 19% Contacted GP 8% Outcomes of attendees to WGH A&E who have had a fall or TLOC (previously or index episode) and agreed to further referral for investigation (n = 133)

16. Falls (and fractures) CQUIN 2011/2012: uptake Regionally suggested ….. Adopted much as written without the specific targets: South of Tyne and Wear: x3 A&E departments ‘Something on falls’ adopted in 3 of remaining 4 North East Primary Care Trusts

17. Information sharing website Policies, protocols, assessment tools, training documents, patient information from group Share with professionals – regionally and nationally Live May / June 2011

18. www.phine.org.uk Information / resources for professionals under the headings: Advice for Patients / People at risk of falls Care Homes Community Falls Documents produced by NHS North East Safer Care Falls Task Group Falls Service Quality Metrics and Local Audit Tools In-Patient Falls Risk Assessment, Intervention and Referral Tools Training Resources Collection of links to relevant information for public and professionals on other sites

19. Care Homes: sharing of good practice Quality Standards: Sunderland Similar process in progress in MRCPCT and Newcastle Middlesbrough, Redcar and Cleveland Primary Care Trust

20. In-patient falls In-patient audit tool based on Reducing Harm From Falls Trusts performed well Consistent gaps: Root cause analysis Peer support Measurement of implementation Exercise programmes Communication of risk at discharge Appropriate footwear Tried to get trusts to match best local practice on incident reporting …. variable success

21. Regional outcome measures Work with NEQOS (North East Quality Observatory System) to use routine data as regional outcome measures Admissions with fractures In hospital mortality for patients admitted with a fracture Split into fragility fracture and fracture neck of femur

22. Joint work with North East Ambulance Service New referral pathway established Jan 2007 (Newcastle) and now in place across whole of North East region Direct referrals from ambulance crews to Falls Services And also link to local Community Care Alarm providers Joint work with Mr. Philip Kyle, North East Ambulance Service, Justine Lockey, Your Homes Newcastle and Dr. John Davison, Newcastle upon Tyne Hospitals NHS Foundation Trust

23. Joint work with North East Ambulance Service And this was what happened to 999 calls for falls …….

24. Joint work with North East Ambulance Service Maintained 4 years out ……. 999 calls for falls Falls assessments 2006 2007 2008 2009 2010 2011

25. Staying Steady Community Exercise Classes Joint work with HealthWORKS Newcastle www.hwn.org.uk Network of evidence-based exercise classes (FaME – Skelton) in community venues (June 2010) Delivered by Postural Stability Instructors from 3 rd Sector Organisation Older people living in the community – falls, fear of falls, risk of falls, osteoporosis Been to falls services – on-going exercise needed Could do with going to falls service but won’t Nothing unexplained about fall / seem too well to go to falls service Screened by NHS physio – referred to falls services if needed

26. Staying Steady – initial outcomes 36 week programme – early results ……. Referral base – ‘self’ biggest category, followed by range of falls services and then GPs Improved objective measures – 30 sec sit to stand, TUG Improved QoL measures – walking outside, fear of falling Improved social contacts

27. Key lessons Importance of consensus approach Benefits of working together and sharing ideas / good practice Importance of identifying the right people to influence and help get things done Need to tackle a problem (falls) from all possible angles Importance of determination and a positive attitude!

28. Future plans Regional falls work – hosted by CDDFT Implementation – group expanded to include relevant trust managers from across the region Regional Falls and Fracture Prevention Strategy Implementation of A&E CQUIN Actions from in-patient falls audit Completion of website Further development of regional falls indicators Active engagement with NEAS Re-audit against Good Practice Recommendations

29. Thank you for listening Questions? Contact Fiona.Shaw@newcastle-pct.nhs.ukFiona.Shaw@newcastle-pct.nhs.uk or Fiona.Shaw@nuth.nhs.ukFiona.Shaw@nuth.nhs.uk Final comments